Individual
SIOUD IDRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
23792 LANDISVIEW AVE, LAKE FOREST, CA 92630-5126
(949) 899-7959
Mailing address
23792 LANDISVIEW AVE, LAKE FOREST, CA 92630-5126
(949) 899-7949
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
E3301391
CA
Other
Enumeration date
04/07/2023
Last updated
04/20/2023
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